![]() Treatment of SCAD has not been described well management should be decided individually for each case, and includes medical therapy, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. 8- 10) The disease also has higher prevalance among cases with collagen disorders, cocaine abuse, severe hypertension, smoking, and oral contraceptives. Of the women with SCAD, one-third are in the peripartum period. Eighty percent of reported cases of SCAD occur in women with no history of heart disease or cardiovascular risk factors, and typically in the left anterior descending artery men tend to present with RCA dissections. 4- 6) A United States population-based study 7) on all-cause acute myocardial infarction (AMI) in pregnancy estimated an incidence of one AMI in every 16129 pregnancies, with a mortality rate reported at 5.1%. Peripartum episodes suggest hemodynamic stress of pregnancy, changes in connective tissue caused by high estrogen levels, and inflammatory changes due to infiltration of eosinophils in the adventitia of the vessel. 1) 2) 4) The precise aetiology and the mechanism of SCAD during pregnancy is uncertain. Smoking cessation was strongly encouraged.Īlthough it is a very rare clinical event, SCAD is most frequently associated with pregnant women or those in the postpartum and commonly seen in middle age, but is not infrequent in older patients. The patient was discharged receiving 81 mg of aspirin and 75 mg of clopidogrel once a day. We did not perform optical coherance tomography (OCT) due to the probability of coronary dissection or occlusion caused by guidewire or OCT catheter. The patient was evaluated for revascularization due to ischemic findings, but thallium-201 myocardial perfusion imaging did not show ischemia. A workup for collagen disease was negative. There have been no cases reported in the literature with WCAA involving all coronary arteries. The patient's right carotid angiography showed an occlusion, and other vessels were normal on CT angiogram. We noticed that this patient had WCAA involving all coronary arteries. 4, 5, and 6), and ventriculography revealed normal wall motion and LVEF of 65%. Subsequent coronary angiogram showed a dual twisted lumen in the proximal and medial segments of all coronary arteries ( Figs. The patient exhibited no ischemic ECG changes, but we determined an abnormal ST-segment depression on exercise testing. The patient had been on clopidogrel, aspirin, and lisinopril for the last two months. The patient's history revealed a previous right carotid artery occlusion, hyperlipidemia, hypertension and severe smoking. At 12 weeks follow-up, she was well and without symptoms.Ī 45-year-old male was presented to cardiology department with mild chest pain. The patient was administered on warfarin, clopidogrel, perindopril and beta-blocker on discharge. Follow-up transthoracic echocardiography showed normal wall motions and ejection fraction. A 2.75×30 mm drug-eluting stent was successfully placed along the dissection, reducing the RCA to a single lumen ( Fig. Ventriculography showed hypokinesis of the inferior wall, and the left ventricle ejection fraction (LVEF) was 45%. 1), with distal Thrombolysis in Myocardial Infarction (TIMI)-3 antegrade flow. Cardiac catheterization showed a spiral dissection of the proximal right coronary artery (RCA), extending downwards to just below the right ventricle branch ( Fig. An electrocardiography (ECG) showed Q waves in the inferior leads. She had been diagnosed with portal vein thrombosis due to protein C deficiency, hypertension and hyperlipidemia. A 60-year-old female was presented to the cardiology department with stable angina pectoris that she had experienced for one year.
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